Self-management of type 2 diabetes: A good idea—or not?
The evidence supports the use of some measures but is questionable on others, including routine self-monitoring of blood glucose.
Group-based vs individual training. The evidence comparing group-based and individual self-management support is inconsistent. In one RCT focused on personalized action-oriented goals for healthy eating, SMBG, taking medications, problem solving, risk reduction, healthy coping, and physical activity, individual education led to reductions in HbA1c levels (–0.51%) after 6 months that were not observed in the group-based education and usual care groups.10 On the other hand, a Cochrane review of trials comparing group-based and individual routine care suggested greater benefits overall in group-based approaches, but with the caveat that many of the included trials had methodological limitations.29
Mobile phone and online interventions? Stay tuned
The jury is still out on interventions like peer advising and telephone, telemedicine, and online support. In a systematic review of 22 trials evaluating mobile phone interventions for self-management (eg, text messaging, phone reminders, and coaching interventions), investigators observed a 0.5% decrease in HbA1c levels over a median followup period of 6 months.30 Various telephone interventions have shown modest and short-term improvements in HbA1c levels, but none of these interventions has improved clinical outcomes.31-33 Combinations of telephone and online self-management are beginning to show promise, but so far the evidence shows only short-term benefit, and clinical outcomes have not been studied.34,35
CASE Based on the available evidence, a number of ways to support Ms. M’s efforts at self-management would be justified. Eliciting her perspective on the options would be well worth the effort. She is not taking insulin, so we would not recommend daily SMBG, but we’d support her if she expressed a strong preference for self-monitoring. Once insulin treatment enters the picture, however, we would strongly recommend daily SMBG to promote patient engagement and safety. And although there is limited evidence to support referral to self-management programs, if a particular program fit Ms. M’s lifestyle, we would refer her nonetheless.
CORRESPONDENCE
Michael Mendoza, MD, MPH, Highland Family Medicine, 777 S. Clinton Avenue, Rochester, NY 14620; Michael_Mendoza@urmc.rochester.edu
